Tag Archives: Ghana

Episiotomy and obstetric outcomes among women living with type 3 female genital mutilation: a secondary analysis

Reprod Health. 2016 Oct 10;13(1):131.FREE

Episiotomy and obstetric outcomes among women living with type 3 female genital mutilation: a secondary analysis.

Rodriguez MI, Seuc A, Say L, Hindin MJ

BACKGROUND: To investigate the association between type of episiotomy and obstetric outcomes among 6,187 women with type 3 Female Genital Mutilation (FGM).

METHODS: We conducted a secondary analysis of women presenting in labor to 28 obstetric centres in Burkina Faso, Ghana, Kenya, Nigeria, Senegal and Sudan between November 2001 and March 2003. Data were analysed using cross tabulations and multivariable logistic regression to determine if type of episiotomy by FGM classification had a significant impact on key maternal outcomes. Our main outcome measures were anal sphincter tears, intrapartum blood loss requiring an intervention, and postpartum haemorrhage.

RESULTS: Type of episiotomy performed varied significantly by FGM status. Among women without FGM, the most common type of episiotomy performed was posterior lateral (25.4 %). The prevalence of the most extensive type of episiotomy, anterior and posterior lateral episiotomy increased with type of FGM. Among women without FGM, 0.4 % had this type of episiotomy. This increased to 0.6 % for women with FGM Types 1, 2 or 4 and to 54.6 % of all women delivering vaginally with FGM Type 3. After adjustment, women with an anterior episiotomy, (AOR = 0.15 95 %; CI 0.06-0.40); posterior lateral episiotomy (AOR = 0.68 95 %; CI 0.50-0.94) or both anterior and posterior lateral episiotomies performed concurrently (AOR = 0.21 95 % CI 0.12-0.36) were all significantly less likely to have anal sphincter tears compared to women without episiotomies. Women with anterior episiotomy (AOR = 0.08; 95%CI 0.02-0.24), posterior lateral episiotomy (AOR = 0.17 95 %; CI 0.05-0.52) and the combination of the two (AOR = 0.04 95 % CI 0.01-0.11) were significantly less likely to have postpartum haemorrhage compared with women who had no episiotomy.

CONCLUSIONS: Among women living with FGM Type 3, episiotomies were protective against anal sphincter tears and postpartum haemorrhage. Further clinical and research is needed to guide clinical practice of when episiotomies should be performed.

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Males’ preference for circumcised women in northern Ghana

Afr J Reprod Health. 2006 Aug;10(2):37-47.

Males’ preference for circumcised women in northern Ghana.

Sakeah E, Beke A, Doctor HV, Hodgson AV.

Navrongo Health Research Centre, P.O. Box 114, Navrongo, Upper East Region, Ghana. esakeah@yahoo.co.uk

ABSTRACT

Female genital mutilation (FGM) still remains one of the challenges facing women in many countries around the world. Efforts to eradicate the practice are on going but the results are still modest due to, among other things, ingrained cultural traditions that expose women to serious health consequences. In Africa where FGM is practiced in more than 28 countries, males have been found to perpetuate the practice. Using baseline data on FGM collected in 1998 by the Navrongo Health Research Centre in Ghana, we examined factors that influence males’ choice of marrying circumcised women. Results from regression analysis show that the illiterate and those who have been to primary school are more likely to prefer circumcised women than those with secondary and higher education. In addition, ethnicity and religion are also significant factors that influence males’ preference to marry circumcised women. A number of policy implications are discussed.

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The changing nature of adolescence in the Kssena-Nankana District of Northern Ghana

Stud Fam Plann. June 1999 30(2)95–111, June 1999

The changing nature of adolescence in the Kssena-Nankana District of Northern Ghana

Mensch BS, Bagah D, Clark WH, Binka F

ABSTRACT

This study reports the results of a primarily qualitative investigation of adolescent reproductive behavior in the Kassena-Nankana District, an isolated rural area in northern Ghana, where traditional patterns of marriage, family formation, and social organization persist. The study is based on in-depth interviews and focus-group discussions with adolescents, parents, chiefs, traditional leaders, youth leaders, and health workers, supplemented by quantitative data from the 1996 wave of a panel survey of women of reproductive age conducted by the Navrongo Health Research Centre. The social environment that adolescent boys and girls in the Kassena-Nankana District encounter and its links to reproductive behavior are described. The principal question is whether even in this remote rural area, the social environment has been altered in ways that have undermined traditional sexual and reproductive patterns. The survey data indicate a considerable increase in girls’ education and the beginning of a decline in the incidence of early marriage. The qualitative data suggest that social institutions, systems, and practices such as female circumcision that previously structured the lives ofadokscent boys and girls have eroded, leading to an apparent increase in premarital sexual activity.

Inconsistent reporting of female genital cutting status in Northern Ghana: Explanatory factors and analytical consequences

Stud Fam Plann. 2003 Sept 34(3): 200-210

Inconsistent reporting of female genital cutting status in Northern Ghana: Explanatory factors and analytical consequences

Jackson EF, Akweongo P, Sakeah EHodgson A, Asuru R, Phillips JF

ABSTRACT

Although many cross-sectional social surveys have included questions about female genital cutting status and correlated personal characteristics, no longitudinal studies have been launched that permit investigation of response biases associated with such surveys. This study draws upon the findings of a longitudinal study of women aged 15 to 49 in rural northern Ghana. The self-reported circumcision status of women interviewed in 1995 was compared with the status they reported when they were interviewed again in 2000 after the government began enforcing a law banning the practice and public information campaigns against it were launched. In all, 13 percent of respondents who reported in 1995 that they had been circumcised stated that they had not been circumcised in the 2000 reinterview; this inconsistency reached 50 percent for the youngest age group. Analysis shows that women who said they had not been circumcised are significantly younger, more likely to be educated, and less likely to practice traditional religion than are women who reported that they were circumcised. Factors that may explain these correlates of denial are discussed, and implications for research are reviewed.

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The limited effectiveness of legislation against female genital mutilation and the role of community beliefs in Upper East Region, Ghana.

Reprod Health Matters. 2009 Nov;17(34):47-54. doi: 10.1016/S0968-8080(09)34474-2.FREE

The limited effectiveness of legislation against female genital mutilation and the role of community beliefs in Upper East Region, Ghana.

Ako MA, Akweongo P.

Navrongo Health Research Centre, Navrongo, Upper East Region, Ghana. maberese@gmail.com

ABSTRACT

Female genital mutilation (FGM) has long been practised in many communities in the Upper East Region of Ghana. Although the Ghanaian state has a long tradition of supporting women’s rights, it has not been successful in eradicating FGM, despite a law against the practice in an amendment to the Criminal Code in 1994 and the Domestic Violence Act 2003. This qualitative study in the Upper East Region examined the role of the state in stopping the practice of FGM through legal means, and why FGM continues to be practised in the community. In-depth interviews were conducted with six state officials, a circumciser, the president of a women’s advocacy organisation, and semi-structured interviews with 32 community members. Although FGM has been criminalised, political support to ensure that the law is effectively implemented has been lacking. FGM education and eradication must be given more priority and significant funding by the Ghanaian state. For interventions to be effective, legal measures need to be combined with social measures. Communities practising FGM must be involved in the planning and implementation of anti-FGM interventions. Successful eradication of the practice is possible if education and dialogue between state institutions, gender and human rights groups and practising communities is strengthened.

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Trends in the prevalence of female genital mutilation and its effect on delivery outcomes in the kassena-nankana district of northern Ghana.

Ghana Med J. 2006 Sep;40(3):87-92.

Trends in the prevalence of female genital mutilation and its effect on delivery outcomes in the kassena-nankana district of northern Ghana.

Oduro A, Ansah P, Hodgson A, Afful T, Baiden F, Adongo P, Koram K.

Navrongo Health Research Centre, P.O. Box 114, Navrongo, Ghana.

Summary

RATIONAL: Female genital mutilation (FGM) is prevalent in northern Ghana, as the practice is seen as a passage rite to women adulthood and thus undertaken just before marriage.

OBJECTIVES: We determined the changes in trend of FGM in deliveries at the Navrongo War Memorial hospital, and compared the outcomes and FGM status.

DESIGN: Retrospective extraction and analysis of delivery data at the hospital from 1(st) January 1996 to 31(st) December 2003.

RESULTS: Of the 5071 deliveries, about 29% (1466/5071) were associated with FGM. The highest prevalence (95% CI) of 61.5% (50.9, 71.2) was in women aged 40 years and above, and the lowest of 14.4% (11.7, 17.0) was in women below 20 years. The all-age prevalence of FGM showed a significant decline (p-value for linear trend < 0.01) from 35.2% in 1996 to 21.1% in 2003. About 6% (89/1466) of mothers with FGM had stillbirths compared with about 3% (123/3605) of mothers without FGM. Again FGM was associated with 8.2% (120/1466) caesarean section rate compared with 6.7% (241/3605) in mothers without FGM. Mean birth weight and frequency of low birth weights were not significantly associated with FGM status.

CONCLUSION: Although there is a high rate of FGM among mothers in the district and is associated with a higher proportion of stillbirths and caesarean sections, practice has shown a significant decline in the district in recent years due to the prevailing campaigns and intervention studies. There is therefore the need to sustain the ongoing intervention efforts.

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Female genital mutilation and obstetric outcome: WHO collaborative prospective study in six African countries.

Lancet. 2006 Jun 3;367(9525):1835-41.

Female genital mutilation and obstetric outcome: WHO collaborative prospective study in six African countries.

WHO study group on female genital mutilation and obstetric outcome, Banks E, Meirik O, Farley T, Akande O, Bathija H, Ali M.

National Centre for Epidemiology and Population Health, Australian National University, ACT 0200, Australia. FGMStudyGroup@who.int

Comment in Lancet. 2006 Jun 3;367(9525):1799-800.

Lancet. 2006 Aug 12;368(9535):579.

BACKGROUND: Reliable evidence about the effect of female genital mutilation (FGM) on obstetric outcome is scarce. This study examines the effect of different types of FGM on obstetric outcome.

METHODS: 28 393 women attending for singleton delivery between November, 2001, and March, 2003, at 28 obstetric centres in Burkina Faso, Ghana, Kenya, Nigeria, Senegal, and Sudan were examined before delivery to ascertain whether or not they had undergone FGM, and were classified according to the WHO system: FGM I, removal of the prepuce or clitoris, or both; FGM II, removal of clitoris and labia minora; and FGM III, removal of part or all of the external genitalia with stitching or narrowing of the vaginal opening. Prospective information on demographic, health, and reproductive factors was gathered. Participants and their infants were followed up until maternal discharge from hospital.

FINDINGS: Compared with women without FGM, the adjusted relative risks of certain obstetric complications were, in women with FGM I, II, and III, respectively: caesarean section 1.03 (95% CI 0.88-1.21), 1.29 (1.09-1.52), 1.31 (1.01-1.70); postpartum haemorrhage 1.03 (0.87-1.21), 1.21 (1.01-1.43), 1.69 (1.34-2.12); extended maternal hospital stay 1.15 (0.97-1.35), 1.51 (1.29-1.76), 1.98 (1.54-2.54); infant resuscitation 1.11 (0.95-1.28), 1.28 (1.10-1.49), 1.66 (1.31-2.10), stillbirth or early neonatal death 1.15 (0.94-1.41), 1.32 (1.08-1.62), 1.55 (1.12-2.16), and low birthweight 0.94 (0.82-1.07), 1.03 (0.89-1.18), 0.91 (0.74-1.11). Parity did not significantly affect these relative risks. FGM is estimated to lead to an extra one to two perinatal deaths per 100 deliveries.

INTERPRETATION: Women with FGM are significantly more likely than those without FGM to have adverse obstetric outcomes. Risks seem to be greater with more extensive FGM.

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